Risk Analysis of Pesticide Exposure Associated with Reduced Cholinesterase Levels in Indonesian Farm Workers: A Meta-Analysis
Abstract
Pesticide exposure remains a major occupational health problem, with the World Health Organization (WHO) reporting between 1 and 5 million cases of pesticide poisoning annually among agricultural workers. This study aimed to analyze the risk factors associated with pesticide poisoning by conducting a meta-analysis of published research. The meta-analysis was performed in four stages: data abstraction, statistical analysis using JASP Version 0.18.3, heterogeneity testing, and publication bias assessment. The random-effects model was applied to the variables of Personal Protective Equipment (PPE) use and length of work, as the heterogeneity test indicated significant variation between studies (p = 0.001). In contrast, the fixed-effects model was used for individual hygiene (p = 0.006). Egger’s test showed no indication of publication bias for PPE use (p = 0.356) and length of work (p = 0.395). The results revealed that PPE use increased the risk of decreased cholinesterase levels by 1.584 times, poor individual hygiene by 1.954 times, and working more than 5 hours by 1.665 times. In conclusion, individual hygiene was identified as the most significant risk factor. Farmers who neglect personal hygiene practices, such as bathing after spraying or changing clothes immediately, face a substantially greater risk of reduced cholinesterase levels due to pesticide poisoning.
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References
1. Shinta DY, Sonata H. Hubungan Kadar Cholinesterase dan Jumlah Leukosit Kasus Keracunan Pestisida pada Petani. Prosiding Seminar Nasional Pelestarian Lingkungan (SENPLING) 2018;561-565. https://repository.unri.ac.id/handle/123456789/9551
2. Budiyono B. Hubungan Pemaparan Pestisida dengan Gangguan Kesehatan Petani Bawang Merah di KelurahanPanekan Kecamatan Panekan Kabupaten Magetan, Jawa Timur. [Tesis]. Surabaya: Universitas Airlangga; 2005. https://repository.unair.ac.id/35428/
3. Zulfania KD, Setiani O, Dangiran HL. Hubungan Riwayat Paparan Pestisida dengan tekanan Darah pada Petani Penyemprot di Desa Sumberejo Kecamatan Ngablak Kabupaten Magelang. Jurnal Kesehatan Masyarakat. 2017;5(3):392-401. https://doi.org/10.14710/jkm.v5i3.17254
4. Oluwoyo T, Kocadal K, Saygi S, Battal D. Determination of Pesticide Residue Content in Fruits and Vegetables from Lagos, Nigeria. Environmental Analysis Health and Toxicology. 2024;39(1):1-7. https://doi.org/10.5620/eaht.2024002
5. Anjaswanti RN, Azizah R, Leonita A. Meta-Analysis Study: Risk Factors for Pneumonia Incidence at Toddlers in Indonesia 2016-2021. Journal of Community Mental Health and Public Policy. 2022;4(2):56-70. https://doi.org/10.51602/cmhp.v4i2.65
6. Ray S, Shaju ST. Bioaccumulation of Pesticides in Fish Resulting Toxicities in Humans Through Food Chain and Forensic Aspects. Environmental Analysis Health and Toxicology. 2023;38(2):1-17. https://doi.org/10.5620/eaht.2023017
7. Octiara DL, Saftarina F. Relationship of Personal Hygiene Behavior with Pesticide Poisoning through Cholinesterase in Blood of Farmers in Pekon Srikaton Adiluwih Pringsewu District 2017. Medula (Medical Profession Journal of Lampung). 2021;11(3):259–265. http://journalofmedula.com/index.php/medula/article/view/256
8. Susilowati DA, Suhartono S, & Widjanarko B. Faktor Pengetahuan dan Perilaku Petani Penyemprot yang Berhubungan dengan Kadar Serum Cholinesterase di Kabupaten Brebes. Jurnal Epidemiologi Kesehatan Komunitas. 2018;3(2):63-67. https://doi.org/10.14710/jekk.v3i2.4024
9. Yogisutanti G, Mulianti IA, Nurmalina I, Hotmaida L, Suhat S. Use of Personal Protective Equipment and Pesticide Poisoning for Workers in Pest Spraying Companies. Media Kesehatan Masyarakat Indonesia. 2020; 16(2):183-191. https://doi.org/10.30597/mkmi.v16i2.9090
10. Azizah R, Martini S, Sulistyorini L, Pawitra AS, Budijanto D, Nagari SS, Fitrahanjani C, Ramadhani FH, Latif MT. Association Between Climatic Conditions, Population Density and COVID-19 in Indonesia. Sains Malaysiana. 2021;50(3):879–887. http://dx.doi.org/10.17576/jsm-2021-5003-28
11. Rusmili SH, Mohamad Hamzah F, Choy LK, Azizah R, Sulistyorini L, Yudhastuti R, Chandraning Diyanah K, Adriyani R, Latif MT. Ground-Level Particulate Matter (PM2.5) Concentration Mapping in The Central and South Zones of Peninsular Malaysia Using a Geostatistical Approach. Sustainability. 2023;15(23):16169. https://doi.org/10.3390/su152316169
12. Wardani RA, Azizah R. Management of Solid Medical Waste at One of The COVID-19 referral Hospitals in Surabaya, East Java. Jurnal Kesehatan Lingkungan 2020;12 (Special Issue):38–44. https://doi.org/10.20473/jkl.v12i1si.2020.38-44
13. Sari AF, Azizah R, Jalaludin J, Rahmawati I, Sulistyorini L, Yudhastuti R, Sumantri A, Jauharoh SN, Zulkarnain OF, Rizaldi MA. A Review of Open Defecation (OD) in Indonesia and The Control with Logic Model. Malaysian Journal of Medicine and Health Sciences. 2022;18(2):157–165. https://medic.upm.edu.my/upload/dokumen/2022031418462623_MJMHS_0959.pdf
14. Sholehhudin M, Azizah R, Sumantri A, Sham SM, Zakaria ZA, Latif MT. Analysis of Heavy Metals (Cadmium, Chromium, Lead, Manganese, and Zinc) in Well Water in East Java Province, Indonesia. Malaysian Journal of Medicine and Health Sciences. 2021;17(2): 146–53. https://medic.upm.edu.my/upload/dokumen/2021040613114320_MJMHS_0789.pdf
15. Maruf MA, Azizah R, Sulistyorini L, Zakaria ZA, Marmaya NH, Pawitra AS, Sumantri A, Jauharoh SN. Management of Organochlorine Exposure to Health Risks in Asia – A Review. Malaysian Journal of Medicine and Health Sciences. 2021;17(4): 332–340. http://medic.upm.edu.my/upload/dokumen/2021100810073745_MJMHS_0960.pdf
16. Wicaksono RI, Manuel ES, Pawitra, AS, Diyanah KC, Keman S, Azizah R, Yudhastuti R. Literature Review: Impact of Organophosphate Pesticide Exposure on Cholinesterase Enzyme Activity and Associated Risk Factors for Poisoning, 2017-2020. Jurnal Kesehatan Lingkungan. 2023;15(4):247–256. https://doi.org/10.20473/jkl.v15i4.2023.247-256
17. Ulva F, Rizyana NP, Rahmi A. The Relationship of Personal Hygiene with Symptoms of Pesticide Poisoning in Horticultural Crop Pesticide Spraying Farmers in Gumanti Valley District, Solok Regency in 2019. Prosiding SainsTekes Semnas MIPKes UMRi. 2019;1:65-69. https://doi.org/10.37859/sainstekes.v1i0.1574
18. Budiawan AR. Risk Factors Associated with Cholinesterase in Onion Farmers in Ngurensiti Pati. Unnes Journal of Public Health. 2014;3(1):1-11. https://journal.unnes.ac.id/sju/ujph/article/view/3533
19. Maruf, M. A., Azizah, R., Sulistyorini, L., Zakaria, Z. A., Marmaya, N. H., Pawitra, A. S., Sumantri, A., & Jauharoh, S. N. Management of Organochlorine Exposure to Health Risks in Asia – A Review. Malaysian Journal of Medicine and Health Sciences. 2021;17(4):332-340. https://repository.unair.ac.id/114519/2/3%20artikel.pdf
20. Rosita B, Mayaserly DP. Hubungan Kadar Enzim Cholinesterase dengan Hipertensi pada Petani Cabe di Kabupaten Tanah Datar. Menara Ilmu: Jurnal Penelitian dan Kajian Ilmiah. 2023;17(2):163-172. https://www.jurnal.umsb.ac.id/index.php/menarailmu/article/view/4113
21. Kurniawati E. Analisis Faktor yang Berhubungan dengan Keracunan Pestisida pada Petani Sayur di Kelurahan Bakung Jaya Kota Jambi. Preventif: Jurnal Kesehatan Masyarakat. 2023;14(3):649-664. https://doi.org/10.22487/preventif.v14i3.985
22. Utami TP, Lestari M, Novrikasari N, Purba IG, Sitorus RJ, Nandini RF, et al. Penurunan Kadar Enzim Kolinesterase Tenaga Sprayer di Perkebunan Kelapa Sawit. Jurnal Kesehatan Lingkungan Indonesia. 2021;20(1):27-33. https://doi.org/10.14710/jkli.20.1.27-33
23. Tarigan Y, Ferusgel A, Ramadhani S, Simanjuntak R, Salmirta CS, Purba I. Influence Factors of Cholinesterase Levels Among Farm Workers in Cikaok Village, West Pakpak District, North Sumatra, Indonesia. International Journal of Allied Medical Sciences and Clinical Research. 2021;9(2):186–191. https://ijamscr.com/ijamscr/article/view/989
24. Suratno S, Purbayanti D, Hildayanti H. Cholinesterase Activity on Palm Oil Plantation Workers in Parenggean, Kotawaringin Timur. Jurnal Surya Medika. 2018;3(2):69–75. https://doi.org/10.33084/jsm.v3i2.100
25. Yuandra RF, Ashar T, Lubis R. Pesticide Exposure and Cholinesterase Levels of Crop Farmers in Tanah Karo District. Berita Kedokteran Masyarakat. 2020;36(8):758–767. https://journal.ugm.ac.id/bkm/article/view/55926
26. Daulay DK, Silaban G, Ashar T. Correlation Between Pesticide Exposure and Cholinesterase Level of Sprayer Workers in PT. Langkat Nusantara Kepong Gohor Lama. Britain International of Exact Sciences (BIoEx) Journal. 2020;2(1):175-184. https://doi.org/10.33258/bioex.v2i1.175
27. Lari S, Yamagani P, Pandiyan A, Vanka J, Naidu M, Senthil Kumar B, Jee B and Jonnalagadda PR. The Impact of The Use of Personal Protective Equipment on The Minimization of Effects of Exposure to Pesticides Among Farm-Workers in India. Frontiers in Public Health. 2023;11: 1075448. https://doi.org/10.3389/fpubh.2023.1075448
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